In 1918, physician William Keen,who had served as a Union army surgeon during the Civil War, reflected on the surgical conditions he and his fellow military doctors faced in the early 1860s. “We operated in old blood-stained and often pus-stained coats, the veterans of a hundred fights. We operated with clean hands in the social sense, but they were un-disinfected hands.” Still worse, he concluded, “We used undisinfected instruments from undisinfected plush-lined cases…. If … an instrument fell on the floor it was washed … in a basin of tap water and used as if it were clean.”
While the conditions that Keen and other surgeons operated in—and the practices that many of them employed—were unsanitary, the tools, some of them shown below, they used were crafted with care and often innovative.